Unintentional injury is a major cause of death and disability in childhood. To date, clinical counseling to prevent child injury through changes in knowledge or injury-related behavior has met with only modest success. The research proposed in this application would explore an alternative approach to the conceptualization of injury risk by examining the context of childhood injury from the perspective of family systems theory. The first two phases of this project involve analysis of data sets from the National Longitudinal Survey of youth. These data sets include information on the health and development of a cohort of children. Injury events among these children will be modeled as a function of antecedent family stresses and resources. In addition, path analysis, structural equations models and latent variable estimation will be assessed with respect to their methodological usefulness in injury research. In the next phase of research, a series of family assessment instruments which support the Resiliency Model of Family Stress, Adjustment and Adaptation will be administered to the families of children treated for unintentional injury in the emergency department. These instruments will be tested for face and content validity to establish their utility in this population. The utility and construct validity of a short form of these tools will also be assessed. In the final phase of this project, families seen in the emergency department for child injury care will be prospectively enrolled and followed over a 6 month period. Baseline measures of family stress, resilience and adaptation will be obtained for comparison with subsequent family injury experience. We hypothesize that a high rate of recurrent injury will be observed among families with high baseline levels of stress or limited coping resources. These studies will begin to explore childhood injury in the context of family systems theory. The results may have implications for novel and efficient injury prevention interventions. In addition, the studies will allow the applicant to develop a set of skills necessary to become an independent clinical investigator in the family and behavioral aspects of pediatric injury.